Proper care of wounds is key to aid healing

Sunday

Jul 28, 2013 at 2:00 AM

As a physician who specializes in wound care, I see people in my office both with complicated new wounds and with old wounds that are not healing. Awareness of some common misconceptions about wound care, along with basic guidelines, could help many people avoid delayed wound healing.

Dr. Kathleen Kelly

As a physician who specializes in wound care, I see people in my office both with complicated new wounds and with old wounds that are not healing. Awareness of some common misconceptions about wound care, along with basic guidelines, could help many people avoid delayed wound healing.

Making sure a wound heals properly starts the moment you initially treat the injury. The first thing you should do with a cut, scrape, or open wound is to rinse the area with soap and water, and then flush with water. As a general rule, tap water anywhere in New Hampshire and Maine is safe for cleansing wounds. Once you have rinsed out the wound, use gauze on the area to try to stop the bleeding.

So how do you know if you should go to the hospital or try to treat the wound on your own? If it is still bleeding in two hours, you should go to the emergency room. If you can still see foreign material in the wound after rinsing it out you should also seek medical attention. If you can see things move in the bottom of the wound such as a tendon or joint, you should keep the wound elevated and covered in gauze on route to the hospital.

Approximately 90 percent of wounds will heal on their own within two weeks. It's rare that someone needs professional medical help with a wound if they have no other underlying health conditions. People with a chronic condition such as diabetes must be extremely vigilant about wounds they sustain, especially on their feet. Those with diabetes often experience nerve damage, which prevents them from realizing the severity of a wound. These people should never walk barefoot and should check their feet daily for wounds as they may not feel them.

Wounds heal best when covered with a bandage, which keeps the wound warm and protected. If the Band-Aid pad sticks to the wound, a layer of petroleum jelly will help. Leaving the wound open to the air dries the wound bed and slows healing. Healing cells need a moist wound base to fill in the space of the wound. It is generally helpful to remove the bandage daily to wash the area gently. Replace a bandage if it gets wet, either from drainage or from outside splashing. It is worth noting that within two minutes of being uncovered, the temperature in the wound decreases to room temperature. It takes four hours for the tissue to return to 98 degrees for healing to resume.

One of the common mistakes that people make when cleaning out a wound is using alcohol or hydrogen peroxide. Both of these cleaners are actually damaging to the healthy wound tissue. Using them repeatedly may inadvertently turn a simple wound into one that will take longer to heal because of damage from the alcohol or peroxide. This same rule applies to straight iodine. There are very few circumstances where you should use straight iodine. I have seen patients in my office who have been cleaning a persistent wound diligently with peroxide. In most cases, stopping the peroxide helps the wound to resolve.

Antibacterial creams such as Neosporin or Bacitracin can be used as a protective barrier for a few days. Continued use can lead to a contact dermatitis that prevents healing. If a wound looks mushy and red after five days of topical antibiotic cream, don't assume the wound is infected. Stop the cream, and if the wound does not improve, seek medical attention. If there is a smell or unusual color of discharge coming from the wound, or for a wound that is not mostly healed at two weeks, it's a good idea to see a doctor.

The process of healing takes time. The first step of cleaning out the wound and protecting it with a bandage is akin to putting a tarp over a leaky roof. It is just a temporary fix. You next need to repair the frame and inside. Your body does this by first making the wound water proof with a fragile, immature skin, which stops the leakage of blood or fluid. It then takes up to two years for the supporting tissue under the new skin to reach its maximum strength, and then it only has 80 percent of the strength of the normal tissue.

By following these suggestions for proper care of acute simple wounds, you should be able to avoid complications. If your wound is related to a chronic medical condition rather than a specific injury, it's a good idea to see a wound care professional.

Dr. Kathleen Kelly is the medical director of the Center for Wound Healing at Exeter Hospital. The center provides a comprehensive outpatient treatment approach to maximize the wound healing process. Kelly is board certified in internal medicine with subspecialty certifications in hospice and palliative medicine and wound healing. For more information about the Center for Wound Healing at Exeter Hospital, call 580-7285.

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